The disclosures herein relate generally to improved medical care for intubated patients, and more particularly to a novel multiple access respiratory port, assembly, manifold, fitting, adaptor, connector and/or access control assembly, and related methods, for ventilating, aspirating, monitoring, sampling, and providing therapeutic delivery to the respiratory tracts of intubated patients, including infants, adolescents, and adults.
Respiratory patient care is a dynamically developing field in medicine, ranging in its needs from infants to the aged. The ranges of respiratory ailments, both temporary and permanent, to which such patients are subjected, are many and varied. For example, the range of procedures for intubated patients may include the following: ventilation, aspiration, oxygenation, sampling, visual inspection, in-line sensing, pressure monitoring, flushing, medicating and/or lavage. Most problems now center or focus on multiple needs of the patient and the accommodation of multiple treatments, some to be performed at the same time. The lack of equipment to easily, efficiently, and safely accomplish the multiple therapies in the best interest of the patient has been and continues to be a concern. It is strongly preferred that these procedures be carried out while the patient continues to be ventilated mechanically. Removal of ventilator assistance could result in a drop in blood oxygen levels with resulting danger to the patient.
In low lung capacity patients, such as premature babies and adults suffering from emphysema, one problem is the removal of accumulated lung secretions. It is undesirable to starve such patients of oxygen during the secretion removal process. Secretion removal is accomplished via a suction catheter which is temporarily positioned via a respiratory access assembly in an artificial airway, i.e., an endotracheal tube placed in a portion of the patient's respiratory tract to provide air (oxygen and other gases) to the lungs of such patients. While this procedure sounds simple, it is fraught with difficulties, particularly when a caregiver must change devices or perform other therapeutic treatments sequentially or simultaneously. In fact, these difficulties may result in the patient contracting ventilator acquired pneumonia (VAP). In addition, failure to adequately seal a respiratory access assembly may cause a compromise of positive end-expiration pressure (PEEP), which in turn may cause sub-optimal ventilation.
One way of addressing these problems is with the use of a rotatable multiple access manifold or “assembly” as the respiratory access assembly. The assembly is adapted to be positioned in operable communication with an artificial airway of a patient and to allow for the connection of multiple devices that may be passed into the respiratory tract of a patient while the patient remains connected to the ventilator. The assembly comprises a distal plate having a port. The assembly includes a proximal plate, which has a first port and a second port. The distal plate is positioned against the proximal plate in a stacked configuration, and each plate is configured to move with respect to the other plate. The assembly may rotate to allow access to the endotracheal tube for multiple devices that may be attached to the proximal plate.
An issue that has arisen in the use of such assemblies is that it is possible, using excessive force, to rotate the assembly before an inserted device has been completely withdrawn. In this case it is possible to sever or slice off a piece of the device, such as a catheter. If this occurs the piece can disrupt the flow of air to the patient or, in extreme cases, travel into the respiratory tract of the patient. It is important in the use of the multiple access assembly that the device be fully withdrawn prior to allowing rotation of the assembly. There is a need to address and overcome these difficulties, preferably with a passive design that functions without the need for operator intervention.